Report to the Delegation of the European Commission in the Philippines Contract No. 2007/147‐653 Technical Assistance to the Mindanao Health Sector Policy Support Programme A Review of Poverty in the Conflict Affected Areas of Mindanao Final Version This Project is funded by A project implemented by the European Union. GRM International BV in Consortium with GRM International Group Ltd., Saniplan GmbH, OIDCI and CREDES. i The content of this publication is the sole responsibility of GRM International BV in consortium with GRM International Group Ltd., Saniplan GmbH, Orient Integrated Development Consultants Inc. and CREDES and can in no way be taken to reflect the views of the European Union. ii Foreword The Mindanao Health Sector Policy Support Programme is part of the European Commission’s commitment to supporting the Government of the Philippines in the reforming the health sector. This support is delivered in partnership with the Department of Health of the Philippines in Manila (DOH) utilising the DOH Field Implementation Management Office in Mindanao, the Centre for Health Development at Regional level, and the Department of Health of the Autonomous Region of Muslim Mindanao (ARMM‐DOH). Over a four year period from January 2008 to January 2012, the programme aims to engage local governments at provincial and municipal level in the conflict affected areas of Mindanao in support of the implementation of the FOURmula One for Health reform agenda. FOURmula One for Health is a policy framework intended to strengthening health services management and delivery in decentralised operating context. It specifically intends to support the achievement health related Millennium Development Goals and National Health Objectives. The programme‐targeted conflict affected areas are listed in the Financing Agreement between the European Commission and the Government of the Philippines as Zamboanga del Norte, Zamboanga del Sur, Zamboanga Sibugay, Lanao Norte, Lanao Sur, Compostela Valley, Davao Oriental, Maguindanao, Basilan, Sulu, Tawi‐tawi, Isabela City, Marawi City and other areas as required. As the conflict affected areas are amongst the poorest and least stable regions in the Philippines, it is hoped that the programme will enhance health governance and health management capacity leading to a general improvement in the health status of these populations. In contributing the health and welfare of the people of Mindanao it is also hoped, to some measure, to enhance the capacity for peace. This survey was designed to collect baseline information and is part of a series of research studies supported by the Mindanao Health Sector Policy Support Programme (MHSPSP). The research is designed to bring greater understanding of the situation in the conflict affected areas of Mindanao and iii provide baseline information for the implementation and evaluation of the FOURmula One for Health initiative in the conflict affected areas. iv Persons Consulted Dr Aggie Sunta MoH, Policy Development and Planning, Secretariat of TA Team Dr Eric Tayag MoH, Director, National Epidemiological Centre Dr Vicky de los Reyes National Coordinator, Field Health Information Survey Dr Sharon Lilly B Valdez MoH‐Mindanao, Medical Officer III Leda C Tejam MoH‐Mindanao, Chief Administrative Officer Augusto C Tapia MoH‐Mindanao, LRIC 10/11 Toto Arenas MoH‐Mindanao, Senior Project Officer, MHSPSP Dr. Melissa M Poot MoH‐ARMM, Senior Programme Officer, MHSPSP, ARMM Dr Paulyn B Rossell‐Ubial Regional Director, DoH, Davao Region Rita Bustamente Programme Officer, ECD Dr Jose Cardona Team Leader. TA for Health Sector Policy Support Programme in the Philippines Lluis Vinyals Health Financing Specialist, TA for Health Sector Policy Support Programme in the Philippines Klara Tisocki Drug Regulation Specialist, TA for Health Sector Policy Support Programme in the Philippines Karin Schlezig Bloom Poverty Reduction Specialist, ADB, Southeast Asia Department, Social Sectors Division. Karl Chua Economist, Poverty Reduction and Economic Management, WB 1 Table of Contents A Review of Poverty in the Autonomous Region of Muslim Mindanao and Conflict Affected Areas of Mindanao ................................................................................................................................................... i Foreword ...................................................................................................................................................... iii Persons Consulted ........................................................................................................................................ 1 Table of Contents .......................................................................................................................................... 2 Abbreviations ................................................................................................................................................ 7 Abstract ......................................................................................................................................................... 9 Introduction ................................................................................................................................................ 11 Literature and Report Review ..................................................................................................................... 11 Understanding Poverty ........................................................................................................................... 11 Poverty Analysis in the Philippines ......................................................................................................... 12 Conflict and Poverty ............................................................................................................................... 14 The Millennium Development Goals ...................................................................................................... 15 FOURmula 1 (F1) for Health ................................................................................................................... 17 National Strategies to Address Health Access and Health Poverty ........................................................ 18 PhilHealth Membership .......................................................................................................................... 19 Identification of the Poor ....................................................................................................................... 21 Discussion of the relevance of PhilHealth in the context of poverty in the RMM and Mindanao is pursued below. ......................................................................................................................................................... 23 Poverty in the Philippines ........................................................................................................................... 23 Overview of Poverty in the ARMM ......................................................................................................... 24 Overview of Poverty in Mindanao CAAs ................................................................................................. 26 Inequality ................................................................................................................................................ 32 Statistical Profile: Demographics and Economy .................................................................................... 34 The ARMM .............................................................................................................................................. 34 Demography and Geography ............................................................................................................. 34 Economy of the ARMM ...................................................................................................................... 36 Mindanao ................................................................................................................................................ 37 Demography and Geography ............................................................................................................. 37 The Economy ...................................................................................................................................... 39 Health Poverty ........................................................................................................................................ 41 2 Health Poverty Indicators ................................................................................................................... 41 General Health Poverty Indicators in the Philippines ........................................................................ 41 Maternal Mortality ............................................................................................................................. 41 Infant Mortality .................................................................................................................................. 43 Nutrition ............................................................................................................................................. 43 Health Poverty in the ARMM .................................................................................................................. 45 Service Accessibility ...........................................................................................................................